A revolution in understanding: how ethics has transformed health care decision making

This paper traces the evolution of a new model of health care decision making, from its beginnings in the collapse of "parentalism," through the articulation of the concept of patient autonomy, and perhaps most visibly to the emergence and institutionalization of the idea of patients' rights. Health care professionals no longer uncritically and inappropriately claim access to knowledge of what is right and good for their patients. In the new model, knowledge of the right course of treatment is discovered through sustained dialogue; ultimate authority is exercised by the patient; and responsibility is shared between patient, family, and multiple health care providers. One test of this new model is the extent to which inevitable ethical conflict is acknowledged.